THE EFFICIENCY OF TOLERANT (PASSIVE) ADAPTATION UNDER THE CONDITIONS OF EXPERIMENTAL POLYTRAUMA

The model of multiple skeletal injuries was reproduced in two groups. 22 animals of the 1st group had stabilization of the right forearm bones and left shin with spoke external fixation device of 2 subsystems with followed osteotomy of the bones of respective segment in the middle third under general anesthesia. During the experiment the injection of dexamethasone and adrenaline during the first twenty-four hours after multiple skeletal injuries prevented the reduce the intensity of the metabolic processes, that was proved by close to initial values of oxygen consumption and carbon dioxide emissions. But to the third day there was no any difference in the metabolic activity in rabbits having and not having adrenaline and dexamethasone. The animals had adrenaline and dexamethasone turned to be in more severe clinical situation. As a result of «normal» intensity of metabolic processes in rabbits during the near time period after trauma there was decrease of survival from 45,5 % to 7,7 %

NEW WAY TO DETERMINE THE TYPE OF ADAPTATION STRATEGY IN EXPERIMENT

Aim: to base and to test new more precise way of determination of the type of adaptation strategy and. intensity of corresponding metabolic shifts in experiment. Methods: the model of orthopedic trauma of two extremities with stabilization of fragments with external fixation devices was rendered in experimental group of 22 chinchilla rabbits. We defined oxygen consumption, carbonic acid excretion and rectal temperature initially and also on the 1st, 3rd and 7th day after the operation. Results. Addition of data of research of oxygen consumption (key criterion of the type of adaptation strategy) with the results of determination of carbonic acid excretion and rectal temperature, correct choice of initial condition of laboratory animal that will be compared and also quantitative characteristics of intensity of metabolic shifts allowed to increase exactness of diagnostics of type of adaptation strategy of laboratory animals in unfavorable conditions

The difficulty of choosing the method of analgesia after total replacement of the lower limb large joints (case report, literature review)

A case of successful treatment of a patient with a periprosthetic fracture of the femur is described. The fracture occurred one day after total hip replacement as a result of a fall, possibly associated with postoperative conduction analgesia. Lower limb large joints total replacement may become the most frequently performed type of elective surgery already in the current decade. The increasing prevalence of osteoporosis, osteoarthritis, rheumatic diseases and hip fractures is an objective prerequisite for it. Despite of all efforts, the problem of postoperative pain control during these surgical interventions currently remains unresolved. There is currently no “gold standard” for pain relief after total hip and knee replacement surgeries. An excellent ratio of effectiveness and safety is demonstrated by multimodal pain relief programs based on peripheral nerve blocks. However, while having undeniable advantages, conduction anesthesia/analgesia has a critically important drawback. The cornerstone of postoperative rehabilitation for patients undergoing total hip or knee replacement is their early activation. All methods of conduction anesthesia are associated with motor blockade. In particular, femoral nerve block causes weakness of quadriceps muscle of thigh, inducing patients’ inadvertent falling when attempting to stand or walk. The situation with the choice of the method of anesthesia after total replacement of the lower limb large joints can be described as “a long way to go”

Acute kidney injury after primary total hip replacement

Surgical interventions that do not directly affect the urinary system can cause excretory dysfunction of kidneys. The aim. To establish the prevalence, risk factors and clinical significance of acute kidney injury after primary hip replacement performed in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology. Materials and methods. We carried out a retrospective analysis of the case histories of 109 patients who underwent primary total hip replacement under conditions of subarachnoid anesthesia in the clinic of the Irkutsk Scientific Centre of Surgery and Traumatology in 2021. Results. Postoperative changes in serum creatinine in 8 patients of the study group met the KDIGO (The Kidney Disease: Improving Global Outcomes) criteria for acute kidney injury. Initial indicators of renal excretory function in the subgroup with acute kidney injury were not different from those in the entire group. Statistically significant correlation was established between acute kidney injury and indicators of oxygen-carrying capacity of blood – initial and minimal postoperative hemoglobin concentration. Acute kidney injury in patients of the study group had a minimal effect on the clinical course of the early postoperative period. None of the patients required renal replacement therapy, re-transfer from the specialized unit to the intensive care unit or any specific treatment. The duration of postoperative stay of patients with acute kidney injury in the clinic did not increase. Conclusions. Acute kidney injury was detected in 7.3  % of patients who underwent primary total hip replacement. Risk factors for the development of postoperative acute kidney injury in  patients of the study group included relatively low initial and  minimal postoperative blood hemoglobin concentrations, which may indicate prerenal mechanism of acute kidney injury pathogenesis. Implementation of the main steps of the “renal protocol” in patients with initial glomerular filtration rate over 45 ml/min/1.73 m2 allows avoiding the development of severe clinically significant forms of postoperative acute kidney injury and complications associated with it in the early postoperative period of primary total hip replacement

Energy metabolism at experimental polytrauma: changes at the prescription of adrenaline and dexamethasone

The aim of the research was to study influence of dexamethasone and adrenaline on the concentration of energy metabolism substrates in blood of Chinchilla rabbits under the conditions of multiple skeletal trauma. We performed stabilization of the bones of right forearm and left shin in 35 animals by wire external fixation device with further osteotomy of bones of corresponding segments. We observed the decrease of activity of metabolism in rabbits on the background of standard treatment. Maintenance of normal activity of metabolism by prescription of adrenaline and dexamethasone caused more intensive use of energy resources of an organism. Imitation of hyperergic reaction of stress-realizing systems in rabbits caused the increase of concentration of glucose in blood and the decrease of concentration of triglycerides. High consumption of energy substrates was provided by more expressed catabolic reaction. The result of hypercatabolism was development of hypoproteinemia, hypoalbuminemia and increase of the risk of fluid shift from bloodstream into the tissues with formation of organ insufficiency

Hormonal type in the conditions of experimental multiple skeletal trauma

In experiment reproduced model of multiple skeletal trauma (fracture of bones of right forearm and lift shin) with stabilization of fragments with external fixation devices in 35 Chinchilla rabbits. All manipulations were realized, at general anesthesia. Standard treatment included anesthesia, antibiotic prophyliaxis and. infusion therapy by common method. Decrease of metabolism activity was registered in the first group of laboratory animals at the standard treatment. That's why besided strandard treatment dexamethasone and adrenaline in average recommended doses was prescripted in the second group of rabbits in postoperative period for correction of posttraumatic hypobiosis. Laboratory control in several hours after the injection confirmed stable increase of level of corticosteroids in blood but it wasn't possible to register increase of concentration of adrenaline. Correlation analysis was realize to study the connection between the contentration of endogenous hormones in blood and. metabolism activity in rabbits in conditions of multiple skeletal trauma. At the consideration data as one array we determined high-significant (р < 0,001) direct moderate correlation between the values of rectal temperature and. the concentration of free thyroxine in blood (rs = 0,414), this connection was strong on the 3rd day after trauma (rs = 0,833; р < 0,001). Also indirect moderate correlation between values of rectal temperature and. the concentration of cortisol in blood of laboratory animals was registered (rs = 0,49; р < 0,001). The results of study of influence of adrenaline and. noradrenaline on the indices of metabolism activity weren't statistically significant. Obtained data allowed to make a conclusion about importance of endocrine activity of thyroid gland in the formation of adaptation strategy

Change of oxygen capacity and lactate concentration in blood in conditions of experimental multiple skeletal trauma

The article is devoted to the experimental study of changes of oxygen capacity and blood lactate concentration in conditions of multiple skeletal trauma. As the result of the research we revealed that indices that characterize oxygen capacity of blood of 22 Chinchilla rabbits in conditions of experimental multiple skeletal trauma didn't have significant changes during first 7 days after trauma. In first 3 days after trauma hyposiderosis was detected that is connected, in authors' opinion, with system inflammatory reaction and. is considered to be the reason of distinct tendency to anemia in a week after trauma. In laboratory animals during 7 days of observation after trauma significant decrease of concentration of lactate was determined. On the basis of obtained data authors concluded adequate delivery of oxygen to the tissues and. absence of circulatory hypoxia in laboratory animals of an experimental group at the realization of tolerant (passive) adaptation in conditions of multiple skeletal traum

SYSTEM OF ANAESTHETIC SUPPORT AT LARGE JOINT REPLACEMENT SURGERIES

The operation of total endoprosthesis replacement of large joints is associated with several anesthetic problems. Solving these problems ensures the safety of these highly traumatic operations and requires the solution of the following anesthetic tasks in the perioperative period: high degree of antinociceptive protection of patients with effective relaxation of the surgical intervention area; prevention of fatty hyperglobulinemia; decrease in the volume of perioperative hemorrhage and prophylaxis of thrombogenic complications. We developed our own program of anesthetic maintenance at major joints replacement. The components of the program are: the type of anesthesia - spinal anesthesia preservation of spontaneous respiration; our method of fat globulinemia prevention, based on maintaining the functional stability of the hepatocyte; our own method of replacement of peri-operative blood loss, based on the additional principle of "normalization of the oncotic blood pressure". Before the operation, patients receive a solution of tranexamic acid at a dose of 10 mg/kg of body mass to inhibit proteolysis (blood preservation technology). This method provides a "dry" operating field, reducing intraoperative hemorrhage. In the early postoperative period (5 hours after the surgery), under the control of whole blood clotting time, patients receive low molecular weight heparin Clexane at a therapeutic dosage of 1 mg/kg of body weight. This provides effective prevention of thrombogenic complications. The application of the developed technique shows its high clinical effectiveness. Over the past 5 years, 5,800 operations for large joint prosthetics have been performed, including 3,200 total hip replacement operations, 2,600 total knee replacement operations. There were no complications with a fatal outcome, in 5 cases fatty hyperglobulinemia was noted, which was stopped by the own method of treatment. There are no thrombogenic complications